Tuesday, December 22, 2015

Healing Back Pain

I've put off writing this post for many years because I know it will be controversial. But we're a few days from Christmas, and I also know this post will be a wonderful gift for some people.

Chronic or intermittent pain, often located in the back, neck, and/or buttocks, is a major driver of personal suffering and reduced productivity in the US and other affluent nations. While pain can obviously have a variety of structural causes, such as sprained ankles or bruising, garden-variety back pain usually doesn't. I've come to believe that such pain is usually psychosomatic in nature-- in other words, caused by the brain but resulting in physical signs and symptoms in the body. It's widely accepted that a person's mental state can affect pain perception, but this idea goes further. Pain isn't just exacerbated by a person's mental state; it's often entirely caused by it.

Conventional medicine is not very effective at treating this kind of pain, which is often attributed to spinal features like slipped or herniated disks that are supposedly irritating or compressing spinal nerves. Yet these spinal features are common in people without pain, are inconsistently associated with pain (1), and surgery to correct them is often no more effective than "placebo surgery" in which an incision is made but the features aren't corrected (2). Injection of powerful anti-inflammatory drugs into the area of the spine that is supposedly causing pain is also no more effective than injecting saline (3). Nearly everyone shows some degree of disc degeneration by the age of 20-- it's evidently normal. Furthermore, a neurologist will tell you that the signs and symptoms of garden-variety back pain are usually difficult to reconcile with a diagnosis of spinal nerve compression.

In other words, there is not much evidence that garden-variety pain in the back, neck, and buttocks is related to structural features of the body, or that typical treatments offer anything better than a placebo effect. The idea that our pain is caused by structural features is an assumption we make because it seems logical (i.e., we feel pain when we injure ourselves, therefore back pain must be due to some sort of injury). This assumption is not supported by the evidence.

The idea that pain often has a psychosomatic origin was pioneered by John E. Sarno, MD, professor of rehabilitation medicine at New York University School of Medicine and attending physician at the Howard A. Rusk Institute of Rehabilitation Medicine at the NYU Medical Center (retired). He has coined a name for this extremely common psychosomatic pain syndrome: tension myoneural syndrome (TMS). Over the years, he has successfully treated thousands of patients for TMS by 1) ruling out structural causes for their pain, 2) giving them the right diagnosis, and 3) addressing the psychosomatic problem directly. The fastest and most effective treatment is simply to become aware of the nature of the problem, after which it tends to resolve quickly.

Here's the idea in a nutshell. In our everyday lives, we generate negative emotions like anger, irritation, and anxiety. That can result from little things like being annoyed about having to do the dishes, listening to a boring speech by your boss, disagreeing with a spouse, and in some cases more serious things like memories of abuse. Most of us try to express our negative emotions in constructive ways rather than throwing things and punching people, so we find other ways to cope with them. We fidget with our fingers, we tap our feet, distract ourselves with music, go jogging or lift weights, bite our nails, and some people do more serious self-harm like self-cutting.

In some people, one of the ways the brain copes with negative emotions is by substituting physical pain. This is a completely non-conscious process, meaning that people aren't usually aware that the brain is substituting physical pain for emotional pain, and they are also not aware of the emotion that has been replaced. It doesn't require deep, dark emotions-- for many people, the tension generated by ordinary everyday stressors is enough.

Here is my personal story. I've had mild-to-moderate chronic pain for as long as I can remember-- even as a child. In middle school, the postural muscles in my back and neck would become tired and painful when I sat in a chair for too long, so I'd study laying down on my bed. I had periodic muscle spasms affecting my neck and upper back (attributed to "pinched nerve" or torticollis), which were not only painful but would produce an asymmetrical head and neck posture that I had to live with for days.

In high school, the chronic pain in my back and neck was rarely severe, usually just a dull, annoying, distracting presence. I was pretty hard on my body with wrestling, cross country, track, and frequent strength training, so I attributed my pain to that. College was about the same.

In graduate school, the chronic pain became more severe and began to spread to other locations, such as my jaw (diagnosed as temporomandibular joint syndrome) and my buttocks and hips (diagnosed as sciatica). I was baffled that a healthy, athletic young man could have so many physical problems.

Here's a list of all the chronic pain locations I've cataloged in myself over the years. These are all typical of TMS, which tends to affect postural muscles in the back and neck, the trapezius muscles, the outer aspect of the buttocks, almost any tendon (commonly knee, hip, foot, shoulder, elbow, wrist, hand (e.g., carpal tunnel syndrome)), and certain nerves like the sciatic nerve and the brachial plexus. I'll start from the top and work my way down:

Jaw (temporomandibular joint syndrome)

Sides and back of neck

Trapezius

Upper, middle, and lower back, near the spine

Outer aspect of buttocks

Sciatic nerve (sciatica)

Anterior hip

Knees

Arch of foot (plantar fasciitis)

Ball of foot (Morton's neuroma)

While still in graduate school, I looked everywhere for solutions. I did yoga for two years, which helped a little bit but didn't solve the problem.

I saw a sports medicine doctor at the University of Washington, who ordered X-rays and pronounced my back to be in excellent shape. He actually came very close to putting his finger on the problem. He clearly saw a lot of patients like me, because he had a diagnostic routine that immediately identified weakness and tension in my hip abductors. He said it was due to psychological stress, and recommended an abductor stretching routine and meditation. The stretching helped, but not the meditation, because I was already doing it every day! Yet although the stretching routine helped my abductors, the pain just recurred somewhere else.

I was ready to try almost anything, even therapies of which I was skeptical. I saw a chiropractor for months, which helped a little bit but didn't solve the problem. I saw an acupuncturist for months, which was pleasant but didn't affect the pain.

Finally, while looking for new ideas, I stumbled across John Sarno's book, Healing Back Pain. I saw that he was an MD in rehabilitation medicine, but his ideas seemed pretty far out. I read Amazon.com reviews for his book, which basically consist of 1,200 people going on and on about how it cured their long-standing pain, turned their lives around, etc. I had never read anything quite like those reviews. I saw that I could buy a used copy of his book for $2. Why not?

I read his book, and immediately recognized myself in the pages. His description of the primary pain locations and characteristics were specific yet matched mine precisely. A month later, the inexplicable pain that had troubled me for as long as I could remember-- the pain that I had tried everything to get rid of-- was 80 percent gone. It's been nearly a decade since I first read Healing Back Pain, and the pain is now closer to 90 percent gone, with occasional flare-ups. I have repeatedly and successfully treated flare-ups by applying his methods*.

I've bought more than ten copies of Healing Back Pain over the years, and whenever one of my friends develops chronic pain that could be TMS, I give them a copy. In almost all cases, they experience a rapid resolution of symptoms. Usually, they keep the book. If you have chronic pain and you're on the fence, just read it. It's so cheap and short that you have nothing to lose.

Scientific evidence supporting the approach is mostly limited to a large number of patient follow-ups that Sarno and his colleagues have conducted, most of which is published in his book, and some of which is published in peer-reviewed journals. Although his methods aren't particularly rigorous, the results do suggest that his approach is extremely effective. A 2007 study by Sarno's colleagues found that the approach is effective for long-standing (greater than 6 months) chronic back pain, particularly pain that has been present for more than 3 years. The results suggest that this treatment is substantially more effective than typical medical therapies. The reason they focused on long-standing pain is to anticipate the critique that the effect is simply due to the spontaneous resolution of symptoms that often occurs in pain syndromes (or regression to the mean).

I acknowledge that the scientific evidence supporting the approach, and particularly the mechanism, is not strong. It has received very little interest from the medical and research communities, so there's hardly any research at this point. I think this presents an excellent opportunity for the biomedical research community to explore a hypothesis that may have the potential to help a lot of people.

* Usually, this involves some new location for the pain, such as knee pain, which I initially assume is due to a repetitive stress injury like tendonitis. I give myself some rest. When the pain doesn't subside and persists for longer than it should have taken the injury to heal, I start to think it's TMS. Then, I'll go back to Sarno's book and see that the location is one of those that can be affected by TMS. The pain usually disappears within minutes, and I immediately resume vigorous exercise without further pain.

55 comments:

I haven't read the book, but I do have recurring lower back pain. I mentioned it to my Doc, after my cousin went in for back surgery to repair 'disc degeneration' at the age of 35. She said "yes, you have degeneration, because you're over 20 years old. No, you don't need surgery... you haven't mentioned any shooting pains down the side of your leg.". And that was that. No meds or other physical treatments suggested. I like her!

I've since found that it is a muscle tension issue, and when I stretch correctly, do my yoga (bridge pose is an amazing healing position for me), get out and walk, and sleep in better positions (on my side, versus belly), my back pain pretty much goes away.

I'm sure stress can aggravate any muscle tension pain, too. So, any stress-relieving activities are bonus pain-relievers. I play sax in a band, read fun books, and do breathing exercises for more stress-relief.

I read his book about 10 years ago after several years of unrelenting low back pain. Prior to consulting an orthopedic surgeon I gave the book a chance, but experienced minimal success. I read Dr. John Sopher's "To be or not to be pain free" and Howard Schubiner's "Unlearn Your Pain" which both take Dr. Sarno's TMS theories to their logical conclusions and include detailed workbooks and exercises.

There is an entire online community devoted to exploring Dr. Sarno's theories, TMSHelp.com, they also have resources for doctors in major cities who apply Dr. Sarno's techniques to treat back pain. Truly a remarkable man that was well ahead of his time.

Sarno changed my life. I was in denial for a long time, but after I finally read the book and stopped my obsession with stretching, physical therapy, and other conventional treatments, I finally got better.

Loved reading your post and agree with you wholeheartedly. As a physio, this is something I see clinically on a daily basis and yet most physicians and many physios and other providers still look for "an issue with the tissues" in a futile attempt to explain pain. Feldenkrais wrote back in the '50s how erroneous it was to think of having two lives - psychic and somatic. Our experiences are embodied and pain is perceived based on the perception of threat - regardless of whether or not that threat is real. Given the numerous neural, endocrine, and immune functions that are affected by stressors (both physical and emotional)it is no surprise that the body would become hypersensitive to threat and manifest a perception of pain in an effort to protect the organism. And such tension from perceived threat and the emotional valence they possess limits movement variability subjecting the organism to increasing stress without recovery or other options.It's a shame that people like Sarno are often vilified for bringing something that's not a "hard science" looking at imaging the tissues or other methods of examining a local symptom without examining the super system.The good news is there are many bright researchers now looking more at these causes of pain (and I think probably any negative, chronic output such as fatigue, anxiety, depression share these similar pathways). Hopefully, these type of approaches won't seem so "alternative" in the future.

For further reading, The Body Keeps the Score by Bessel van der Kolk is an excellent read on much of this thru the lens of trauma.

I've not tried Sarno's approach, so don't have any personal experience with it. I will say though that I feel as strongly about Egoscue as you (and Howard Stern!) feel about Sarno and treating TMS.

I started having back pain after I became overly sedentary as a result of a meniscus tear. At first, I thought the pain was weight related, but when it didn't go away with weight loss, I decided it was muscle atrophy. But it didn't go away with weight training (I worked for a few months with one of Doug McGuff's BBS trainers) either.

So there I was at the first AHS symposium in LA, hobbling around with my cane, and taking a scary amount of Advil each day. Not sure what happened, but I believe it was a herniated lumbar disc. And what was pain that made it uncomfortable to walk became pain that made it so that I couldn't turn over in bed. I started doing medical treatment, had the MRI, tried the spinal injections, as well as more than one chiropractor, and eventually had an ortho (whose practice supposedly included the Washington Redskins) tell me I needed to fuse most of my lumbar vertabrae.

Fortunately, a handful of folks (one of them Jack Kruse) told me that I needed to talk with a neurosurgeon, and the young doc I saw (I called him Doogie Howser) from Georgetown told me that advice was "bordering on criminal." We agreed I'd wait and try more weight loss before trying microsurgery.

Around that time, I wrote about this on my blog, and someone suggested Egoscue in the comments. I liked the idea (back pain is related to all of the postural muscles, not just the core), and signed up. It took several months (six or so I think), but I went from being unable to turn over in bed to walking more than a mile easily. And I haven't taken an Advil in the 4 years since!

Now, all of this said, what's not clear to me is whether Egoscue was the saving treatment I think it was (lots of other folks are similarly happy with it) or whether it was that time is a pretty good healer too. And if you are doing something like Egoscue (which involves daily exercises), it means that you aren't doing what is not helpful, which is just sitting around.

Frankly, Egoscue was way, way more expensive than a $2 copy of Healing Back Pain. So I think it might be smart for folks who've had chronic pain like you did to check Sarno's plan out first. But for folks who had an acute issue like I did, or who don't respond to Sarno, you might find an Egoscue therapist really helpful. I don't mind the $$$ I spent!

I read Sarno's book over a decade ago. I remember lots of talk about repressed anger.

It didn't do anything for my mild intermittent low back pain. What did help was Mark Verstegen's Core Performance program. But that required about an hour a day (six days/week) of exercise, stretching, foam rolling, flexibility movements, etc) - more time than I wanted to spend on it. What helps now is being sure to incorporate low back extension strength training into my overall weight training program (30-40 minutes twice weekly).

Back when I had an office-based practice, I recommended Sarno's book to several of my patients who weren't doing will with conventional approaches. None reported significant improvement.

I found myself incapacitated by lower back pain 15 years ago. A friend gave me Sarno's book and she refused to tell me what the book was about because she said if she told me, I woulnt read it. It sat on the shelf for a year. One day, out of desparation, I read the book. More or less overnight I cured my back issues and have been just about pain free ever since. Really a life saver.

It is somewhat of a coincidence that you mention Dr. Sarno's work, as I have just read one of his books within the last few months. I started to develop back pain only while I was sitting at work. I moved to a desk that allowed me to stand up and sit down, and then I started to feel intense pain in my hand while typing. On the weekends I would go rock climbing (which is great to release suppressed anger), and my body would feel 100% until I returned to work on Monday. I googled wrist pain and fell upon Dr. Sarno's name, read his book, and all pain was gone by the very next workweek (and it has not returned). The material seems like complete baloney, but I'd rather get great results as a fool than suffer a bad outcome as a genius or a skeptic. It's actually quite a relief that a scientist such as yourself is granting some credibility to his perhaps less than rigorous findings (although I won't be the judge of his credibility). It is no stretch of the imagination that the mind, given all of the pain it is capable of creating, is capable of creating the sensation of pain in the body.

Ditto for me. One of the most salient point of his book is to AVOID recommending typical interventions such as massage, exercise and surgery. If a patient takes such actions, this draws the patient away from focusing on the psychosomatic nature of their back pain and hinders recovery. Instead, he recommends informative sessions highlighting the interaction of the brain and back.

A physician friend pointed out to me recently that doctors are rewarded for their ability to improve subjective ratings of patient pain. This has served as a major impetus to prescribing opioid pain relievers and may well have detracted from more rational treatment such as outlined by Sarno.

Thanks for the article I found it very interesting and agree with the comments I am a Sport Therapist and run an sport injury clinic in Liverpool UK. I have attended a number of course by a South African Physiotherapist, his name is Doug Heel (check him out on youtube) who lectures on muscle activation techniques and their causes, as with your article it is thought it is from stressors I use techniques which help clients identify the stressors and help them put controls into place, I have been using these techniques for over 2 years with amazing results as we say the mind affects the physiology of the body and visa versa. I will read this recommended book Thanks Bill Pirrie

This is an uncanny coincidence. Sarno's work was recommended to me yesterday by my yoga trainer when I asked her if found that some people got better in one place of their body only to get worse in another. (My longstanding gut issues had been feeling great, but then my head started to hurt and have vertigo. I was feeling like a hypochondriac. Not a pleasant feeling.) She recommended A Divided Mind. I will still see the ENT, but I will give Sarno a read. Thank you.

Bingo! Yes Dr. Sarno is right on. I had the same experience. Sure I have structural issues and some of the chronic issues are physiological, but most of it is internalized psychological stress. Yes it is mostly in the head.

I suffered from severe skeletal pain, especially my lower back. When stress was high I had terrible muscle spasms in the trapezius muscles. I thought it was a natural consequence of aging. In my weight loss regimen I eliminated grains for 30 days just to see if it helped my metabolism along. One morning about two weeks in I realized something was "different" but it took me a few minutes to realize what was different--a complete absence of pain. I thought it was a fluke until I ate wheat again at the end of the 30 day period and the pain came roaring back.

Refraining from grain keeps me mostly pain free, headaches are rare too. For a while I was waking up on Saturday mornings with pain and it took me a while to figure out that on Friday nights a few bites of challah bread were the culprit. When I have pain it can almost always be traced back to some dietary indiscretion, and some "clean eating" for a few days clears it up. Even if this is psychosomatic, I'll take it because I feel so great and I have control over my pain trigger. There are a lot of people who have experienced similar relief from grain elimination. I'm not alone. It's not Sarno, but it works. Glad to know that there is another alternative for people who aren't into a dietary approach. I will suggest it to people who just can't give up the grains.

@StephanGood to hear that you have gotten relief. But if my experience has any relevance in general, there are solid root causes which lead to systemic degeneration at rates above aging. I am much older than you and my symptoms began at a later age (mid 30’s) and the number of symptoms has accumulated and apparently arenot at all unusual. The first tissues to go are connective then mucosal (extra-cellular matrix may be important) then nerves and smooth muscle. Skeletal muscles are last, very late in the game. I did not to think about this until I was 70 when I felt really sick for the first time. Pure serendipity in correlations between diet closely spaced and health changes led me to Paleo which was the rage at the time. Paleo beliefs turned out to be mostly fantasies (Dr. Kurt Harris excepted) but the focus on critical thinking (i.e. experiment) proved invaluable. Conventional nutrition advice does not seem to apply to me either. Now 6 years later I have seen very slow systemic improvements but I began my metabolic experiment too late. Although my back and neck no longer trouble me and I have no joint problems, other degenerations which began decades earlier have continued on their course. You may be interested in a book by Esther Gokhale, 8 Steps to a Pain-Free Back . Well written and illustrated but her implied arrow of causation is facing 180 degrees backwards. It is useful to consider why the posture and health may be related in that way. So maybe there are silver linings and kernels of truth to be found.

There are limits to what Sarno's techniqes can accomplish. I could 'fix' everything but a sequestered chunkola of disc in the spinal canal in a place that is inoperable unless life threatening is not fixable. Very disappointing that macrophages don't eat it up. I thought they'd do the job but no.

Nice post Stephan. Talking with you one would not guess that you have been suffering from chronic back pain for such a long time! I have long suspected that a similar mechanism is linked with the work of “healers”:

If you haven't done so already, I'd highly recommend checking out Todd Hargrove's Better Movement book (and blog), and also Paul Ingram's painscience.com

There's been lots of research recently highlighting that pain is a complex phenomenon, that it is not an exact measure of physical damage, and that many factors, including beliefs and emotions can have powerful effects.

To say pain is "psychosomatic" however, is perhaps an over simplification.

The above resources are a great introduction into the latest science based approaches to the management of chronic pain.

Todd Hargrove is a friend of mine and we've talked at length about this issue. I've also read most of his book. It's not an area of expertise for me but I think his ideas make a lot of sense. However, nothing has helped my pain like Sarno's book. In fact, reading Healing Back Pain is the only thing that has made any significant difference out of the many approaches I tried over a decade. As I said in my post, I don't know whether Sarno's mechanism is exactly correct and I think it should be subjected to more research, but I can say confidently that his technique has tremendous therapeutic value for me and many others.

I'm really happy that you decided to write about this important subject. Only by spreading the information we can help the people suffering from TMS without knowing what is the reason behind the physical symptoms.

My life stopped for several months back in 2012 when I all the sudden got really severe leg pain. It was like someone would have been stabbing me with the knife to my leg. On the other hand occasionally the pain was more like electric shocks. The bottom line is that the severity of the pain was something that was really difficult for me to handle.

I visited so many different doctors, and got all the strongest pain medicines that there was, but the pain did not go anywhere. I was on sick leave several months in a row, being able to just lie on the sofa - because actually I felt that the pain always got worse if I tried to sit (conditioning). Also my leg was insanely sensitive for cold. Just a light breeze made my leg react strongly.

Luckily, I eventually found one doctor here in Finland who understood well the complexity of chronic pain. He gave me pointers to start looking myself from more holistic view. Mind and body are tightly connected to each other. I read book written by this doctor, and in the book he was talking a lot about Doctor John Sarno. Soon after I ordered couple of Sarno's books: Healing backpain, the mindbody prescription & The Divided Mind: The Epidemic of Mindbody Disorders.

Reading the books was amazing for me. Like you said, I immediately recognized myself in the pages of healing back pain. I had the typical personality traits and so on. Actually already while reading the book, the pain started to subside. I felt so much relief. Of course the pain tried to come back several times, but in really reasonable time I was able to fully recover from the symptoms. Of course I know, that I have the ability to generate such symptoms, so basically the symptoms may try to return sometime. And it was not just the leg pain. Long before I had been diagnose with chronic prostate pain and I was constantly suffering from heart burn as well. By Following Sarno's teachings I have recovered from these symptoms as well.

In general I can say that the experience changed my life. I'm so grateful for Dr John Sarno. I have also helped few of my friends by given them the book (with good results). The unfortunate thing is that not everyone is willing to accept the fact that their mind might be responsible of generating physical symptoms. That's why I have not pushed the book for everyone, because sometimes you can see that they are not just ready to accept the message.

I couldn't help myself, so I googled "John Sarno Science Based Medicine", specifically to see what the website of that name has to say on the subject. They've never done an expose, but they've taken digs along the way.

One article "Why Do People Turn to Alternative Medicine" is titled like a think piece but is really just yet another hit piece about the irrational irrationality of some bozo who fell for alternative medicine after curing back pain by reading a John Sarno book. What a doofus, he cured his pain but caught a much worse case of alternative medicine!

There's really no mincing words - I think that site is evil. The people are fine, they mean well I'm sure, but their mission is not about helping people who are sick and hurting. I want to give a name to their ideology, to describe it to them so they see the ugliness for what it is, but then I'd be committing the same fallacy they're committing.

In any event, I see this site as the exact opposite of theirs.

I've been wandering these and various other webpages for almost a decade now, traversing the evidence-based spectrum, from Lyle McDonald to Taubes, etc. Seen it all. Over time I started to remark to myself how the Internet was chock full of people in pain looking for help. Only recently did I realize I was one of those people, duh! My illness brought me to mainstream medicine, New Age spirituality, paleo, vegetarianism, self-help books galore, drugs galore, all the places sick people look for help.

None of it helped until I turned to the community of illegal drug users. One can learn a lot about self-medicating from these folks, and it's quite perverse that we give our governments money and authority to hunt these people down and cage them. But I digress.

Anecdotally, I recently discovered that stimulants are the best method for managing whatever ails me I have found yet. They tame my unquenchable desire for and interest in food, which I didn't even realize was unquenchable. And they mitigate my latent desire to be away from people and seek solitude. And keep me from constantly self-censoring/monitoring socially. Again things that I didn't even know were impulses until a couple months of relief after taking stimulants - currently Modafinil.

Funny thing is, I met with a counselor almost 15 years ago to help sort things out in my life. My insurance paid for it. After an hour of chatting he told me I had a clear case of ADD and sent me to a psychiatrist. A doctor. I sat across from the doctor for about 10 minutes, said some words, and the doctor surmised I probably did not have ADD and should start out with Paxil instead. She grabbed a handful of samples from a bowl on my way out the door to get me started. And so begins the story of how I lost 15 years of my life to alternative therapies when all I needed was some damn ADD medication.

I had back problems - had times when I couldn't even walk. The medical advise I got was bad - they kept telling me to 'take it easy' 'don't lift anything heavy.

My son got me started in doing bar-bell squats a few years ago - now at 60-years old I squat 185Lb and am still increasing. My back problems are history.

The key is to start out light - slowly increase - eat enough protein - see 'starting strength' as a good place to start. If you are eating vegan, you are screwed.

Stress is the key - we don't get enough then lose strength and then your back can start pinching nerves. Not only do you get stronger muscles, you get stronger bones and tendons. (Side benefits of lower fasting blood-glucose - best type of exercise for reversing T2D. )

One last point - strength is a much better predictor of mortality than BMI

This is all well and good (actually, not really that well or that good)...Nobody, and I mean nobody, seems to be discussing the landmark study from 1984, and the subsequent 47 other studies that have followed the initial investigation, done by Biering-Sorenesen out of Glostrup, Denmark (http://www.ncbi.nlm.nih.gov/pubmed/6233709).Now referred to as the 'gold-standard' in prediction and prevention of Low Back Trouble.

Keeping in mind that "the plural of anecdote, is not data".

Discussing psycho-somatic tools to deal with low back trouble is only treating the pain side of the equation. The more important and relevant side of the equation is function. Chasing pain is a wild goose chase, at best. The best results, have been focused on the goal of increasing function to a point where pain is irrelevant.

Your Sarno story is pretty amazing, and I have heard it from many others - from at least four personal friends and many commentators on my blog. I have no doubt his method works for many people.

But I have a problem with how Sarno explains how his method works. The reader is left with the impression that mainstream science cannot account for why cognitions and emotional states can affect pain. But in fact there is in fact a TON of science that is relevant there: the neurophysiology of pain, including descending modulation of nociception; central sensitization; placebo effects; the effects of pain education and CBT style therapy; the neuromatrix model for pain; the biopsychosocial model for pain. There are thousands of pages of textbooks on this material and Sarno cites to NONE of it, preferring a model that is based on outdated Freudian notions of id, superego, etc.

None of this means that his methods don’t work, and I agree that they are in most cases harmless to try.

But if he has indeed discovered a method to cure what is one of the biggest health problems in the world, that method should be explained in ways that enhance its credibility and allow everyone to understand who can benefit, when, where, how and why. I think Sarno is a bit old now but I hope his followers are starting to make this effort.

I read Sarno's book more than 25 years ago. As I recall, it was then called Mind Over Back Pain and it changed my life. I'd broken my back in high school by falling off a horse. I also had lots of trauma in my middle grade and teenage years. Following the break, I had pain in my lower back, on and off, for about a decade. The pain was enough to sideline me for days at a time. It wouldn't seem that Sarno's book should have worked for me as I assumed the pain was related to my prior back injury. But I noticed that pain occurred following stress and so that's when I picked up the book. Sarno's approach eliminated my back pain and changed my life. It's been nearly three decades since I first read it, all remains well, and I can't recommend his book highly enough.

Thank you for writing this post Stephen. I have not read the book, but have through 2 years of my own struggles discovered similar ideas.

I developed stress induced anxiety and depression which manifested itself as weight gain and chronic pain 6 months after birthing my 3rd child in 4 years. During this time I was also working at a demanding full time job. It all became too much, and culminated in a nervous breakdown. At the time I didn't know what it was an was in an out of the hospital complaining of severe neck and back pain. They would take images and say to me you, everything looks fine, you have a strong body! They did comment I had some anxiety but I thought it was because of the pain. I did go and see a well respected psychologist for an initial appointment and she told me 'You have a neck problem, you are in too much pain to deal with your issues right now, come back when your neck doesn't hurt'. I managed to convince an ER doctor to get an emergency appointment with a neurologist and he also pronounced me fine with no issues.

It was all so confusing, and at the time I had no idea how psychological trauma can manifest itself into intense pain.

I finally met a physiotherapist who taught me that I have control over my muscle tone, and there started my journey of trying to 'unwind' my body. At the beginning I would spend upwards of 3 hours per day focusing on my trapezius muscles and trying to let them go. I then had to connect my brain over time to all the muscles Stephen mentioned and use all sorts of queuing words to relax the muscles like 'melt, love, happy, safe'.

My physiotherapist I work with now, uses a model called connect therapy. It is based on work done my a physiotherapist in Vancouver Canada as part of a PHD thesis and continuing clinical work. In my case my sub optimal thoracic function is the driver for my pain. This is caused by various tight postural muscles that they cause rib shifts and dysfunctional movements. The fascinating thing is that when she gently holds my various shifts in place, I will always immediately do a 'sympathetic sigh', which is my nervous system settling. I also often feel very joyful, and will spontaneously smile. There is no change in noticeable pain level, as my pain is quite low, but my nervous system which is connected to my mood can perceive she is changing things. Physiologically it is difficult to feel happy and calm when your body is under tension and stress, but your body can't let go of the tension and stress until you feel happy and calm. They are so connected!

Another effect stress has on the body, is it affects your breathing patterns, which can over time cause dysfunctional breathing patterns. My understanding is the diaphragm and the action of breadth is essential for proper deep core functions and stability which is essential for back health.

Thanks for stopping by. Your points are well taken. I also have a hard time with the Freudian stuff. Freud was not really a scientist and many of his views were downright bizarre. But he did make some valuable contributions that were accurate and continue to be relevant to TMS: 1) his idea that the mind is guided both by conscious and non-conscious forces, and 2) the finding that emotions can cause marked physical manifestations in the body.

In Sarno's defense, he's an MD who published Healing Back Pain in 1991, at a time when presumably a lot of the information you're referring to was unknown. He's a clinician rather than a researcher so he was probably not on the cutting edge of information. He developed his ideas in the 1970s and he's now long retired and in his 90s. Regardless of how he justifies it mechanistically, he did develop a system that appears to work well.

I don't know whether or not his mechanism is correct, nor am I very familiar with the research you mentioned, but I can say that my experience is at least consistent with his model. If I behave as if his mechanism is correct, I get very good results. I've proven that to myself over and over again. Nothing else has ever worked significantly. But I acknowledge that you could probably come up with other models that would be consistent with my experience.

I do think it's worth mentioning that his model is consistent with at least some of the research you mentioned, such as descending modulation of nociception and placebo effects. There is nothing in his model that contradicts the possibility that descending modulation of nociception is involved in TMS. He wrote extensively about the role of placebo effects in pain (his clinical results, and my own results, are difficult to reconcile with a placebo effect due to their duration). He also acknowledges that the mechanistic details of TMS remain fuzzy, leaving the door open to a variety of possible mechanisms connecting emotions to pain, weakness, and muscle tension.

I’ve been following your work for some years, but have never felt compelled to write until now.

I read your post with interest, but also a certain amount of frustration (needless to say not directed at you personally), because I happen to know that there is a mind-body method which is very effective in helping people with chronic back pain and the type of pain you describe in your post, and yet it still seems to be largely unknown, even by very knowledgeable, open-minded researchers such as yourself.

I am talking about the Alexander Technique.

Research on the Alexander Technique is still in its infancy, but as regards back pain, for instance, a randomised controlled trial published in the BMJ in 2008 concluded: ‘One to one lessons in the Alexander [T]echnique from registered teachers have long term benefits for patients with chronic back pain.’ You can read the full research here: http://www.bmj.com/content/337/bmj.a884.full .

The (testable) rationale behind the Alexander Technique is roughly as follows: there is a preferred, dynamic attitude of the head to the neck, and of the head and neck to the back and limbs, which brings about a natural lengthening of the spine and free breathing in all activities; this ‘head-neck-back’ relationship tends to take undue pressure off spinal and other joints and to enable free, mechanically efficient movement. (It is worth mentioning regarding the plausibility of this hypothesis that the eminent physiologist Sir Charles Sherrington, who did pioneering work on spinal reflexes, wrote approvingly about the Alexander Technique and its emphasis on the head-neck region.)

Very young children and pre-industrialised peoples tend to have this preferred head-neck-back relationship working naturally, but the majority of modern people interfere with it, due to subconscious habits of strain and tension. With the aid of an Alexander Technique teacher, it is possible to unlearn these habits by bringing them to consciousness. In practice, this involves having one-to-one lessons with an Alexander teacher who can use his or her hands to subtly adjust your head-neck-back balance in simple activities, such as standing, sitting, bending, squatting and walking. In this way, you can re-educate your kinaesthetic sense so that wrong habits can be perceived and prevented. In the process, pain that is caused by habits of ‘misuse’ can be alleviated and often eliminated altogether.

The Alexander Technique bridges the dichotomy between seeing this type of musculoskeletal pain as down to ‘structural’ causes on the one hand (such as a slipped disc), or ‘entirely caused by’ ‘a person’s mental state’ on the other. Both approaches imply a split between mind and body, which is not merely a philosophical problem but a practical one too.

If someone habitually sits for hours a day at a computer in a slumped posture, putting pressure on the lumbar spine, eventually they may get pain and a slipped disc; an approach, such as surgery, that treats the slipped disc without addressing the postural habits that lead to it is not addressing the cause. However, the same person may have experienced chronic pain long before having a slipped disc, and so an approach which suggests that, in the absence of structural causes, the pain is ‘psychosomatic’ or ‘entirely caused by’ ‘a person’s mental state’ is clearly missing the mark too. The person sitting at the computer may be under stress, worried and depressed, and his or her slumped posture may reflect this, but the ‘physical’ aspect of the pain caused by the mechanical factors involved in the slumped posture needs to be addressed as well, and can’t in practice be separated.

As far as I am aware, it is only the Alexander Technique which does not separate mind and body in this way and which addresses the factor of ‘misuse’ in causing pain. It is educational (or rather re-educational) in nature and does not attempt to address symptoms directly; however, they often improve indirectly when a person learns to ‘use’ himself or herself better as a whole in daily life.

All of the symptoms you mention, Stephan, are suggestive of misuse and those for which I believe lessons in the Alexander Technique may prove effective. The Alexander Technique also has an explanation for why the pain often seems to travel around the body, because until interference or misuse in the head-neck-back region is addressed and the person is treated as an integrated whole, other approaches will be merely palliative and result in compensatory bad habits, or, as John Dewey put it, ‘a different sort of badly’.

For anyone wanting to read more about the Alexander Technique, I recommend ‘Freedom to Change’ by Frank Pierce Jones.

The best way to find out more about the Alexander Technique is to have one-to-one lessons with a qualified teacher. In the US, teachers can be found at AmSAT: http://www.amsatonline.org/ ; in the UK and worldwide teachers can be found at http://www.alexandertechnique.co.uk/ . Other countries have their own Alexander Technique bodies.

Sarno was no help to me but Feldenkrais was(appeared to be - I cannot prove my relief, temporally-correlated to my Feldenkrais experiences, wasn't coincidence).

https://www.painscience.com/articles/mind-over-back-pain.php

> I couldn't help myself, so I googled "John Sarno Science Based Medicine", specifically to see what the website of that name has to say on the subject. They've never done an expose, but they've taken digs along the way.

Paul, who runs painscience.com, is affiliated with Steve et. al. & has done some work on the SBM site so I don't know the specifics of what you read but I wouldn't take it as "their" (SBM's) official stance until they specifically address Sarno. He's kind of supportive so SBM may be too.

> Feldenkrais wrote back in the '50s how erroneous it was to think of having two lives - psychic and somatic

_________Dr. John Sarno’s career has also been about debunking structuralism in back pain.21 In 1984, he first wrote:

There is probably no other medical condition which is treated in so many different ways and by such a variety of practitioners as back pain. Though the conclusion may be uncomfortable, the medical community must bear the responsibility for this, for is has been distressingly narrow in its approach to the problem. It has been trapped by a diagnostic bias of ancient vintage and, most uncharacteristically, has

_________

If not structure, then what? And who says that?

Neurology and homeostasis. Another Australian, sassy pain researcher Dr. Lorimer Moseley, has been doing excellent research and “outreach” on this topic for years now, constantly encouraging clinicians to understand pain not as an inevitable consequence of biomechanical stresses and tissue trauma, but as an output of the brain strongly affected by many considerations — many of wh

Thank you for this article. I have been struggling with severe lower-back issues and have had so many diagnostics. Some doctors spoke of herniated discs, some said problems with the SI-joint and of course some said 'there is nothing wrong with you'. I have tried everything from physical therapy (usually the first step) to osteopathy (no regular doctor will refer you to).

I will order the book and see if it is helpful to me. I do truly hope so, since i'm 31 now and have had severe pain since I was 20.

Even if it does not work for me, I do hope and believe you will help a lot of people with all sorts of pains. So again, thank you.

Unfortunately, this and posts of this nature, are exactly the problem for many people, myself included. While I accept the idea that pain can be psychosomatic and placebo helps etc., there are too many cases where "real" pain is attributed as psychosomatic. Then those patients that would actually have a condition that could be fixed by medical intervention, do not get help as this kind of attitude gains popularity, that "most pain is psychosomatic" I personally have only one kidney, which started to cause pains in my back and side of my ribcage at the age of 20 years after playing Badminton 4 times a week for many weeks. I have struggled with the pain for 18 years now - I have seen several doctors and the kidney has been examined with MRI, Ultrasound etc. In the end all doctors say "Kidney does not feel pain, your pain is most likely psychosomatic" And I get no help. After years and years it was finally discovered, that the single kidney has grown very large and the badminton swing is causing mechanical stress to the area, which is then irritating the nearby tissues. When I stopped playing Badminton, the pain went away. If I do some other sport that causes mechanical stress, the pain comes back. There are some other factors to this also, which I wont discuss here, but this is just an example that a pain can also be real and doctors who dismiss pain as psychosomatic, cause immense suffering to many patients. This is why I always cringe when I see posts like these dismissing pain or any other medical condition as psychosomatic. Unfortunately I do not have peer reviewed double blind placebo controlled studies to back my own situation, but I have 18 years of experience with the problem. Also, I've always been remarkably pain free otherwise - I do not have pain in my lower back (unless I strain it in the gym), I do not have pain in my knees, jaw or any other part of my body. I very seldom have even a headache.

Hi Stephen,its great to hear scientists discussing this and as you know well its difficult to convince others based solely on your experience. People should be skeptical but I feel I owe Sarno my life...no exaggeration. Things had gotten so bad I lost my job and was essentially destitute.I have listed all the testimonials from respectable sources as these were really helpful for me and others. https://corpusmentis.wordpress.com/2015/07/18/of-testimonials-and-anecdotes/

The lecture is now on Youtube for free so no excuses not giving it a look at least. Like Stephen I totally agree that the scientific basis is weak but the outline is accurate.You have to experience it to believe how dramatic these effects can be. It blew my mind and I became somewhat obsessed telling people about it...only to observe a glazed face reaction :D Chronic pain is a total bitch to deal with and in my blog I listed over 30 different approaches I took to try and beat it. Until I read a damn $5 book! its one of those too good to be true things and didn't read the book for 9 months after buying. Anyways thanks for bringing this to wider attention. it needs some serious study

That is great, thanks for sharing. In particular, I didn't know about the RCT, which is much more convincing than the studies I cited in my post. I also didn't know his lecture is online. Looking forward to watching it.

Thanks for sharing your view for the matter as well. I want highlight thatpsychosomatic pain is really common phenomenon and I can assure you that what you just mentioned in your story, happens so often other way around as well.

In general doctors are not trained to consider psychological reason for pain. So often pain is attributed to be caused by some structural abnormalities which are not really causing the pain. There are thousands of stories from Sarno's patient who have been suffering decades from the pain because the pain has been attributed to physical abnormality even it's not really causing the pain.

This certainly does not mean that the doctors should give up from physical examination of the patient. Actually that's something they really don't do properly these days, they rather write prescription of pain killers. Physical reasons must be ruled out of course, that's for sure. The bottom line is anyway that doctors should be aware of the possibility of psychological reasons for the pain. The goal must be of course that everyone can be helped.

Also its good to underline that just telling the patient "it's probably psychosomatic" is not enough. It requires much more than that to get rid of pain caused by psychological pain. Sarno states in his books that maybe 20% of people suffering from psychosomatic pain may get relief just by reading his book. 80% should participate to educational program which is designed to threat TMS (name of the syndrome). In order it to help, patient really needs to accept the diagnosis, otherwise ego is still in charge and no improvement will occur.

And lastly, I could not help noticing that you used the word "real" pain which might be interpreted that the psychosomatic pain would not be real. Psychosomatic pain is VERY REAL. Psychosomatic means that the reason for the pain resides in your mind, but the symptoms are real and physical.

I would like also point out that practically all Sarno's patients state that their pain gets worse after certain activity or inactivity. That's psychological conditioning. For someone, the pain gets worse when they sit down. For others when they start certain physical activity. This is explained by the pain strategy and conditioning. You would actually need to read the book in order to properly understand the pain strategy and conditioning.

Anyways, my point was that ignoring psychosomatic reasons for pain is huge issue as so many people suffer from it, but it should not in anyway mean that other valid reasons can be ignored. It is important to rule out any possible physical reasons for pain as well, but I must underline that the doctor should be very careful and conscious here. Misdiagnose is always an issue, no matter which way it happens.

Thank you for writing about this. My wife works with people in pain all day long. Even when there is a clear, physical reason for it, she often finds that the pain doesn't always get better (or stay better) without non-physical changes, too.

Sorry it took me a while to get your comments posted. They got caught in my spam filter for some reason.

I welcome your perspective but I am skeptical of its relevance to me, for the following reasons: 1) I have good (not perfect) posture, and working on it further (e.g. yoga, standing desk) has never helped the pain; 2) the pain went away almost completely, without changing my posture or movement patterns, when I read Healing Back Pain.

I've had a real struggle with embracing TMS versus "real" pain. When I first encountered lower back pain I found reading Sarno did in fact help, but two years later I descended into such incredible sciatica that I was literally awake crying at night. I had to succumb to a cortisol injection and some Gabapentin.

A few months later, having somehow gotten past the pain and resuming normal life (in Sarno style!), I found myself leg-pressing a bit too "deep" and had an immediate electric jolt of pain -- I swear I could feel the disc bulge. While the searing pain went away within a couple of weeks without serious intervention, the bottom of my left food went numb, a symptom that lasts today (two years later). I have a hard time reconciling that with a purely brain-driven condition. What's difficult about the Sarno approach is that I have to embrace returning to regular life (e.g., leg pressing) but if he's wrong, doing just that could be the very worst thing!

The thing is, pain clearly has structural/physical causes in some cases. That's why it's important to see a doctor to rule out physical causes before assuming the pain is TMS. Ideally you would see a doc who understands TMS, because many docs will assume that any nearby abnormality they see (e.g., herniated disc) could be causing the pain, when often the two aren't likely to be related.

According to what I've understood from Lorimer Moseley is that all pain is a sign of an underlying problem. But the degree to which we suffer from that sensation is essentially an illusion of the mind.

Not only do herniated disks not correlate with back pain, but having an MRI that identifies these deformations can actually make pain worse. It gives back pain sufferers something concrete to latch onto which only reinforces the neurological pattern of the pain.

I think the problem when talking about this kind of things that happen in the brain is that we associate them with 'mental problems'. That somehow if pain originates in the brain that means you're 'crazy' or should just 'get over it'. When in my layman's understanding it should viewed as something that's an experience that can be conditioned over time depending on our approach and attitude.

I understand your scepticism as to the Alexander Technique’s relevance to you and clearly you can be the only arbiter of this; I hope I have at least made you and your readers aware of the Alexander Technique and perhaps aroused your curiosity.

Really the Alexander Technique can only be understood by having a course of one-to-one lessons with a skilled teacher, where it is possible to test the Technique’s hypotheses critically in the crucible of one’s own experience. Scepticism in this regard is of course healthy – as long as one can suspend disbelief sufficiently to actually attend a lesson and give it a fair try!

There are several explicit and implicit assumptions in your reply to me that I’d like to attempt to tease out and address. Please feel free to correct me if I have misunderstood or misrepresented your position.

Firstly, you say: ‘I have good (not perfect) posture, and working on it further (e.g. yoga, standing desk) has never helped the pain’.

Assumption 1 (explicit): ‘I have good posture’ (and by implication know what good posture is). I have never met you, much less given you an Alexander lesson, so I can’t assess the veracity of this claim. However, I do know that what is ordinarily considered to be ‘good posture’ often involves excessive stiffening and tightening of muscles, so that the head is fixed on the neck and pulled backwards and downwards, breathing is restricted, the chest is raised, the lumbar curve exaggerated, and the legs stiffened. In my experience, this is true regardless of whether the good posture advocate is a Pilates, yoga or Gokhale teacher, ballet dancer or drill sergeant. None has the easy upright balance of the toddler or hunter-gatherer tribesperson (although the Gokhale teacher may claim to teach this).

I also note that you say: ‘[T]he postural muscles in my back and neck would become tired and painful when I sat in a chair for too long, so I'd study laying down on my bed’; and that ‘I had periodic muscle spasms affecting my neck and upper back (attributed to "pinched nerve" or torticollis), which were not only painful but would produce an asymmetrical head and neck posture that I had to live with for days.’ You may, of course, say that your posture has changed and improved since then; however, both of these statements are suggestive of the influence of what F. M. Alexander termed ‘misuse’ on your pain. His fourth book, The Universal Constant in Living, contains an interesting case study of a pupil with spasmodic torticollis whom he helped, sent to him by a doctor.

Assumption 2 (implicit): ‘The Alexander Technique teaches or is about “good posture”’. Whilst it is likely a person’s ‘posture’ will improve as a result of having Alexander lessons it does not follow that the Alexander Technique teaches or is about ‘good posture’. The concept of ‘posture’ implies something effortful, a fixed position, whereas we are seeking to economise on effort in the Alexander Technique and there are no fixed positions. Alexander’s concept of conscious good ‘use’ is infinitely more subtle than any idea of good posture, and is more to do with the moment-to-moment conscious refusal to engage in harmful habits of neuromuscular co-ordination, in stillness or in movement. It applies to all the activities of daily life, whether simple activities such as bending to pick something off the floor, or complex skills such as playing the piano or surfing. The basic premise is this: use affects functioning; by improving use you improve functioning.

Assumption 3 (implicit): ‘The Alexander Technique is somehow similar in its approach or efficacy to working with posture when doing yoga or using a standing desk’. As I hope I have argued by now, the Alexander Technique is radically different from yoga or changing one’s posture by standing at a desk rather than sitting. It does not attempt to address posture directly, by, for example, trying to ‘stand up straight’ or ‘pull one’s shoulders back’, etc. All such ‘posture’ approaches make the unwarranted assumption that it is possible to be shown what good posture is, and then achieve it by an exercise of will (‘doing something’). Alexander pointed out that that this belief is a delusion, since for the majority of people their kinaesthesia (sense of muscle tension and relation of body part to part) is unreliable, and cannot be trusted as a guide to better postural balance or co-ordination.

I hope that I have provided sufficient in the way of argument by now for you to at least reconsider these conclusions; although, as I say, the only way to make a truly informed decision about the Alexander Technique is to have one-to-one lessons with a skilled teacher.

You say that ‘the pain went away almost completely, without changing my posture or movement patterns, when I read Healing Back Pain.’ Clearly you have benefitted remarkably from Dr Sarno’s approach and if you are persuaded that his approach holds the answer for you, perhaps there is no need to seek further. However, I do note that after ten years, whilst your pain has ‘90 percent gone’ you still get ‘occasional flare-ups’ involving ‘some new location for the pain’. Whilst it is impossible to say what would have happened had you invested a similar length of time in learning the Alexander Technique, my own experience is that it increases self-knowledge in such a way that one can perceive in a concrete, cause-and-effect way exactly what one is doing to cause one’s pain and prevent it, rather than getting these seemingly random ‘flare-ups’ in different locations, with no obvious cause.

In conclusion, I hope you do not perceive my comments to be a criticism of you personally. I hold you in high regard and have benefitted from your knowledge and research for several years. It is just my honest belief that the Alexander Technique has the potential to help many people and that it deserves to be more widely known; no doubt a similar motivation about Dr Sarno’s approach inspired you to write this post.

Yes, I do realize that psychosomatic pain is really common. But what I tried to convey that this line of though has become too common. As with your reply - I detect a slight hint between the lines, that even you are not convinced that my pain is not psychosomatic, as you refer to the pain starting with certain activity (like badminton in my case) Well - it will be impossible to convince you or some doctors if they are fixated to this line of thought. I could give you a million scenarios which are similar to badminton, but do not cause the pain. But also as Jonh said, it could be the other way around too, and then trying to imagine the pain away, could be more harmful, as the actual condition is just getting worse. I have many examples of this within my friends too. Tryin to imagine heart pain away, when it's actually a heart attack or trying to strech backpain away, when it's a heriated disc.

My experience was similar to yours, Stephan, while I read 'Healing Back Pain' in 2010. I saw myself....a lightbulb moment. I have also bought several copies of Sarno's books and given them out. I would say it has been 99.9 % effective for me. Most people I have given the book to assumed they knew what it was about and didn't read it...but just wrote it off. Or, they lied and said they read it but I knew they didn't by the incorrect things they said about it. Many people just aren't open to the whole concept. Their loss. I am glad I was one of.the 20% for whom it worked. Thanks for posting about this. I hope you reach more people with this post.

Well, add me to the list. 5-6 years ago I developped crazy right shoulder, trap, and deltoid pain, 24/7. After months, lots of BS and money with ART and other chiropractor stuff with zero relief, began blogging about it and both Kut Harris and Doug McGuff recommended Sarno. Dismissed it at first (same reason everyone does), but eventually ordered it.

I began experiencing relief literally as I read the introduction. So, basically, treatment was a dose of 15-45 minutes of reading, as required. Two weeks later pain was gone. Two flair-ups in months to follow, one lasting two weeks and the second, one week, and not a thing since.

Fast forward to almost 2 years ago and I got lower back pain, which went away but then manifest as left hip and calf pain, very severe, though intermittent. MRI confirmed L4-5 herniation, exactly the same as my dad and two brothers had. They all had same symptoms, all had surgery, all successful, and for two of them, they were nearly five years into successful recovery.

But I persisted. Since Sarno wasn't doing it, I did a bunch of other stuff, like the Teeter hang-ups, etc. Standing desk. Vibrating heating pads, etc. I came to the conclusion that everything works and doesn't work. Not permanent.

So, I finally had the surgery, basically in & out in four hours, 2-3 week light recovery. It worked, but for a bit of lingering numness in my left toe. So, I guess my message is, has to be the correct treatment for what's going on.

Thank you for sharing this blog about your experience with intermittent back pain and how you deal with it, its very educational and i am going to send this information to a friend who seem to be experiencing same degree of pain.

Hi Stephen, Not sure if your still monitoring this thread but I have had a desk job for 15 years and generally suffered quite a bit of the pain types similar to what you describe. I will add in that I developed an anxiety disorder a few years back(resolving it now)and oddly, aside from relieving anxiety, the occasional time I had to resort to a benzodiazepine, I noticed that they also worked as the best painkiller/muscle relaxant I have ever had. 1mg Ativan worked better than 2 extra strength Robaxecet. It worked so well that I had to be determined not to reach for them as a pain relief tool I will read the book, but I wonder if this adds credibility to the idea. Thoughts?

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